=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477502177
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK J. MELE D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2006
-----------------------------------------------------
Last Update Date | 12/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2826 MOUNT CARMEL AVE
-----------------------------------------------------
City | GLENSIDE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19038-2245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-886-7880
-----------------------------------------------------
Fax | 215-886-0848
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2826 MOUNT CARMEL AVE
-----------------------------------------------------
City | GLENSIDE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19038-2245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-886-7880
-----------------------------------------------------
Fax | 215-886-0848
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DS027434-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------